Posts tagged: Obamacare

Truck, Meet Hole

By , October 30, 2013 11:44 am

Here’s the relevant provision in the Affordable Care Act, a provision that President Obama touted again and again and again and again:

(a) No changes to existing coverage
(1) In general Nothing in this Act (or an amendment made by this Act) shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on March 23, 2010.[42 USC Sec. 18011 (a)(1)] (Emphasis supplied)

Nope, the Affordable Care Act doesn’t require you–the individual–to terminate that health insurance plan you like. Nope, you don’t even have to get up from the couch. Your friendly federal government, in the form of regulations promulgated by Health and Human Services, will terminate it for you, if your insurance provider or group plan:

-eliminat[es] of all or substantially all benefits to diagnose or treat a particular condition,

-increase[s] . . . a percentage cost-sharing requirement (such as . . . [your] coinsurance . . .),

-increase[s] . . . a fixed-amount cost-sharing requirement other than a copayment (for example,deductible or out-of-pocket limit). . . if the total percentage increase in the cost-sharing requirement . . . exceeds the maximum percentage increase (as defined in paragraph (g)(3)(ii) of . . . [S]ection 54.9815–1251T),

-increase[s] . . . a fixed-amount copayment [by greater than essentially the medical inflation plus $5.00],

-impose[s] . . . [or] decrease[s] an overall annual limit on the dollar value of benefits, [or]

-[if an employer] decreases its contribution rate [essentially, by more than 5%].

(Some emphasis and incidental formatting/punctuation supplied)

Those who are gluttons for punishment can read HHS’s summary of the sordid details here. If you want to read the fine print, click on the link at the very end of the summary. (Oddly, the other links, or at least the ones I tried, don’t work.)

Or you can read my copy here (scroll down until you find the yellow highlights). Have fun: Interim Final Regulations_HHS-OS-2010-0015-0001

A final comment. The HHS regulation makes sense. The Affordable Care Act is supposed to deliver better healthcare–supposed to. And the regulation is an attempt to deliver on that promise to those with existing plans that they like and want to keep. Each of the reasons for terminating your coverage makes sense if you accept the premise that the requirements represent a safety net, a blockade to prevent your health insurance company from reducing your benefits. But that’s not how President Obama sold the Act. As the videos linked to above demonstrate, he promised unequivocally that you could keep your health insurance, no if, ands, or buts, and knowing full well that you probably would not be able to.

Would the Act have passed if he had been up front about this? I don’t think so.

It Was Hubris That Killed the Beast

By , October 30, 2013 9:51 am

I’ve been watching the Sebelius/Obamacare hearings this morning. The Secretary keeps reminding us that the ACA is the law of the land. Her choir members on the dais use their solos to remind viewers that Republicans should be rooting for the ACA rather than gloating over the website’s failures. And they may be right.

But then there’s this: the ACA passed on the barest of majorities. In the House, the vote was 219-212–with not a single Republican saying yes. In the Senate, it was 60-39, again with no Republican (Senator Jim Bunning, R-Ky, did not vote). If you prefer your votes in terms of percentages, the vote in the House was 50.57% to 49.43%, in the Senate, 60% to 39% (and that vote ignores the shenanigans the Senate employed to act before Scott Brown joined that august body). Add all the ayes together, and you’ll find that 50.15% of Congress voted for the law, and 46.92% said no. And with that and President Obama’s signature, the Affordable Care Act did, in fact, become the law of the land, and the Federal government assumed control of 1/6th of the economy of the United States.

All that to say this, or rather, to repeat an anecdote about Senator Daniel Patrick Moynihan and some advice he gave President Bill Clinton:

Twenty years ago, when he was trying to persuade Bill and Hillary Clinton that universal health care was a politically unrealistic goal, the late Sen. Daniel Patrick Moynihan repeated one insistent warning: Sweeping, historic laws don’t pass barely.’They pass 70-to-30,’ he said, ‘or they fail.’

Moynihan was not alone in this opinion. The Politico story continues:

Four years ago, when he was trying to persuade Barack Obama that he would pay a terrible price for jamming health care reform through a reluctant Congress on a partisan vote, White House chief of staff Rahm Emanuel begged his boss to settle for a vastly scaled-down plan.

If the Affordable Care Act fails, it will not be because Republicans opposed it. It will be because Democrats ignored the advice of Moynihan and Emanuel: massive, historic legislation requires massive, bipartisan support. If you don’t have it, you suffer the consequences.

Hubris. It was hubris that killed the beast.

First They Came to Encourage Us to Take Aspirin . . .

By , December 13, 2012 11:39 am

First the good news:

Aspirin is a wonder drug, one that virtually all men over 45 and woman over 55 should take to keep the arteries clear and cancer at bay. So says Dr. David Agus, a professor at USC’s medical school, in an Op-ed in today’s New York Times.

Many high-quality research studies have confirmed that the use of aspirin substantially reduces the risk of cardiovascular disease. Indeed, the evidence for this is so abundant and clear that, in 2009, the United States Preventive Services Task Force strongly recommended that men ages 45 to 79, and women ages 55 to 79, take a low-dose aspirin pill daily, with the exception for those who are already at higher risk for gastrointestinal bleeding or who have certain other health issues. (As an anticoagulant, aspirin can increase the risk of bleeding — a serious and potentially deadly issue for some people.)

New reports about aspirin’s benefits in cancer prevention are just as convincing. In 2011, British researchers, analyzing data from some 25,000 patients in eight long-term studies, found that a small, 75-milligram dose of aspirin taken daily for at least five years reduced the risk of dying from common cancers by 21 percent.

Dr. Agus is so excited about aspirin that he argues, “why not make it public policy to encourage middle-aged people to use aspirin?”

Which leads me to the bad news:

Dr. Agus apparently can see no end to such policy initiatives, at least when his money is at risk because of someone else’s bad health practices:

[W]hen does regulating a person’s habits in the name of good health become our moral and social duty? The answer, I suggest, is a two-parter: first, when the scientific data clearly and overwhelmingly demonstrate that one behavior or another can substantially reduce — or, conversely, raise — a person’s risk of disease; and second, when all of us are stuck paying for one another’s medical bills (which is what we do now, by way of Medicare, Medicaid and other taxpayer-financed health care programs).

Now, who can’t see the benefits of everybody eating better, exercising more, and so on? I can. But I can also see a problem here: one man carrying out his duty can easily become another man’s oppressor. And a woman with one finger on the pulse of America and the power to call out the nannys when that pulse rate increases, is likely a woman with too much power.

In Oral Arguments for the recent Obamacare case, Justice Scalia asked Solicitor General Verrilli whether if the government could mandate that we buy health insurance, it could also mandate that we eat broccoli. Supporters of Obamacare laughed at the idea. As James Stewart wrote in The New York Times, in an article titled “Broccoli Mandates and the Commerce Clause,”

The Supreme Court itself has said: “The principal and basic limit on the federal commerce power is that inherent in all Congressional action — the built-in restraints that our system provides through state participation in federal governmental action. The political process ensures that laws that unduly burden the states will not be promulgated.” And absurd bills like a broccoli mandate are likely to fail other constitutional tests. (emphasis supplied)

All I can say in response to that is, “Mr. Stewart, meet Dr. Agus.”

A Silver Lining for Romney?

By , June 28, 2012 11:24 am

At least Romney talked taxes when he signed Romneycare into law:

Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar. Second, we helped pay for our new program by ending an old one — something government should do more often. The federal government sends an estimated $42 billion to hospitals that care for the poor: Use those funds instead to help the poor buy private insurance, as we did.

In contrast, Congress and President Obama explicitly avoided using the word tax--until, that is, they finally had to argue their case in court.

Scalia Hits The Nail — And Hard

By , June 28, 2012 9:50 am

From Scalia’s dissent (at page 190 of the opinion), joined by Kennedy, Alito, and Thomas, in the Affordable Care Act case:

The Court today decides to save a statute Congress did
not write. It rules that what the statute declares to be a
requirement with a penalty is instead an option subject
to a tax. And it changes the intentionally coercive sanction
of a total cut-off of Medicaid funds to a supposedly
noncoercive cut-off of only the incremental funds that the
Act makes available.

The Court regards its strained statutory interpretation
as judicial modesty. It is not. It amounts instead to a vast
judicial overreaching. It creates a debilitated, inoperable
version of health-care regulation that Congress did not
enact and the public does not expect. It makes enactment
of sensible health-care regulation more difficult, since
Congress cannot start afresh but must take as its point of
departure a jumble of now senseless provisions, provisions
that certain interests favored under the Court’s new design
will struggle to retain. And it leaves the public and
the States to expend vast sums of money on requirements
that may or may not survive the necessary congressional

The Court’s disposition, invented and atextual as it is,
does not even have the merit of avoiding constitutional
difficulties. It creates them. . . .

Hurrah for the limits the Court imposed on the Commerce Clause. Boo because the Court struggled so hard to find a tax. Double boo on a Congress that didn’t have the guts to call it a tax in the first place.

Affordable Care Act: It’s About Power, and It Always Has Been

By , June 8, 2011 3:23 pm

Ilya Shapiro nails it, and apparently, so did the judges of the 11th Circuit Court of Appeals. Obamacare–the Affordable Care Act–is and always has been about power. Washington wants is. The people, at least people like me, don’t want to give it to them.

As the lawyer representing 26 states against the federal government said, “The whole reason we do this is to protect liberty.” With those words, former solicitor general Paul Clement reached the essence of the Obamacare lawsuits. With apologies to Joe Biden, this is a big deal not because we’re dealing with a huge reorganization of the health care industry, but because our most fundamental first principle is at stake: we limit government power so people can live their lives the way they want.

This legal process is not an academic exercise to map the precise contours of the Commerce Clause or Necessary and Proper Clause — or even to vindicate our commitment to federalism or judicial review. No, all of these worthy endeavors are just means to achieve the goal of maximizing human freedom and flourishing. Indeed, that is the very reason the government exists in the first place.

And the 11th Circuit judges saw that. Countless times, Judges Dubina and Marcus demanded that the government articulate constitutional limiting principles to the power it asserted. And countless times they pointed out that never in history has Congress tried to compel people to engage in commerce as a means of regulating commerce.

In case anybody cares, I feel the same way about Climate Change. Even conceding that the globe is warming, I’m not willing to kneel before the would-be climate demigods, certainly not before them move from their Mount Olympus mansions and give up their jets. Yes, Al, I’m talking about you.

Good Idea, Bad Execution

By , February 1, 2011 9:49 am

In an effort to make the case that the so-called Individual Mandate under Obamacare is unconstitutional, a group of South Dakota state lawmakers introduced a bill that would require South Dakota citizens 21 and over to buy a firearm “sufficient to provide for their self-defense.” In explaining the purpose behind the proposed law, Rep. Hal Wick (R-Sioux Falls) said,

Do I or the other cosponsors believe that the State of South Dakota can require citizens to buy firearms? Of course not. But at the same time, we do not believe the federal government can order every citizen to buy health insurance.

He should require citizens–including himself–to buy and read a pocket Constitution: States, unlike the Federal government, do not have enumerated powers under the U.S. Constitution. The knock against the Individual Mandate is that it exceeds the reach of Congress’s enumerated and implied powers.

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